Mixon, Wade
Mixon, Wade is an individual health care provider with primary practice located at 1480 Maple Grove Church Rd , Dunn NC 28334-7692. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Mixon, Wade can be contacted via phone (910) 567-7155.Contact Information
Primary practice address
1480 Maple Grove Church Rd
Dunn NC 28334-7692
Phone: (910) 567-7155
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X | 23170 | North Carolina |
Profile Details
| NPI number | 1164993804 |
|---|---|
| LBN Legal business name | Mixon, Wade |
| Credentials | LCAS-A |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 6th, 2018 |
| Last updated | Dec 6th, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164993804 | NPPES |
| North Carolina | MEDICAID | 1427087709 | |
| North Carolina | Other | 01 |
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